Int J Oral Maxillofac Implants. 2014;29 Suppl:239-55. doi: 10.11607/jomi.2014suppl.g4.2.
The aim of this study was to systematically review the evidence for immediate implant loading in partially edentulous patients with extended edentulous sites and evaluate potential treatment modifiers.
An electronic search was performed in Medline, Embase, and Central to identify studies investigating the outcome of implants subjected to immediate loading (IL) (less than 1 week), early loading (EL) (1 week to 2 months), or conventional loading (CL) (more than 2 months) with implant-supported fixed dental prostheses (IFDPs) in partially edentulous patients with extended edentulous sites, ie, at least two adjacent teeth are missing. Only human studies with at least 10 cases and a minimum follow-up time of 12 months, reporting on solid-screw-type implants with rough surfaces and a diameter of at least 3 mm, were included. Weighted means of implant survival rates and risk ratios for implant survival at 1 year using meta-analytic tools were calculated to perform the following comparisons: IL vs EL, IL vs CL, and IL in the maxilla vs mandible. Noncomparative studies reporting on IL and EL protocols were summarized through descriptive methods.
The search provided 3,872 titles, 837 abstracts, and 444 full-text articles. A total of 24 publications that comprised six comparative studies (five randomized controlled trials, one nonrandomized controlled trial) and 18 noncomparative studies were included for analysis. The comparison of weighted mean survival rates revealed no statistically significant difference between IL (97.9%) and EL (97.8%, P = .9405), and between IL (100%) and CL (99.3%, P = .3280). Meta-analysis showed no statistically significant difference in implant survival at 1 year between IL and EL (RR 0.90; 95% CI 0.30, 2.70; P = .502). A meta-analysis comparing IL and CL could not be performed due to the low number of failures. No statistically significant difference was found for IL implants placed in the maxilla vs the mandible (RR 1.55; 95% CI 0.49, 4.84; P > .05). Due to the small number of IL implants placed in the anterior, a comparison between implant survival in anterior vs posterior zones was not performed. Treatment modifiers were bone quality, primary stability, insertion torque, ISQ values, implant length, the need for substantial bone augmentation, the timing of implant placement, and the presence of parafunctional and smoking habits.
IL presents similar implant survival rates as EL or CL for partially edentulous patients with extended edentulous sites in the posterior zone, as long as strict inclusion/exclusion criteria are followed. There is a lack of evidence for IL of multiple implants in the anterior zone of partially edentulous patients. Preliminary evidence suggests that IL may be equally successful in either the maxilla or mandible. Further research is needed before IL in partially edentulous patients with extended edentulous sites can be recommended in everyday practice.
本研究旨在系统地回顾在有广泛缺牙区的部分缺牙患者中即刻种植的证据，并评估潜在的治疗修饰剂。
在 Medline、Embase 和 Central 中进行电子检索，以确定研究结果为在有广泛缺牙区的部分缺牙患者中，植入物即刻负荷（IL）（少于 1 周）、早期负荷（EL）（1 周至 2 个月）或常规负荷（CL）（超过 2 个月）的植入物支持固定义齿（IFDP）的结果的研究。只有至少有 10 例且随访时间至少 12 个月的人类研究，报告使用粗糙表面和直径至少为 3 毫米的固位螺钉型植入物的研究才被纳入。使用荟萃分析工具计算了 1 年时种植体存活率的加权平均值和种植体存活率的风险比，以进行以下比较：IL 与 EL、IL 与 CL 和上颌 IL 与下颌 IL。通过描述性方法总结了报告 IL 和 EL 方案的非比较研究。
检索提供了 3872 个标题、837 个摘要和 444 篇全文文章。共有 24 篇出版物包括 6 项比较研究（5 项随机对照试验，1 项非随机对照试验）和 18 项非比较研究被纳入分析。加权平均存活率的比较显示，IL（97.9%）与 EL（97.8%，P=0.9405）之间以及 IL（100%）与 CL（99.3%，P=0.3280）之间无统计学显著差异。荟萃分析显示，IL 与 EL 之间 1 年的种植体存活率无统计学显著差异（RR 0.90；95%CI 0.30，2.70；P=0.502）。由于失败病例较少，无法对 IL 和 CL 进行荟萃分析。上颌 IL 与下颌 IL 之间无统计学显著差异（RR 1.55；95%CI 0.49，4.84；P>0.05）。由于在前牙区植入的 IL 数量较少，因此未在前牙区与后牙区之间进行种植体存活率的比较。治疗修饰剂包括骨质量、初级稳定性、植入扭矩、ISQ 值、种植体长度、大量骨增强的需要、种植体放置的时间以及功能紊乱和吸烟习惯。
只要遵循严格的纳入/排除标准，IL 为有广泛缺牙区的后牙区部分缺牙患者提供了与 EL 或 CL 相似的种植体存活率。在前牙区植入多个 IL 的证据不足。初步证据表明，IL 在上颌或下颌同样有效。在推荐在有广泛缺牙区的部分缺牙患者中进行 IL 治疗之前，还需要进一步研究。
